1144. Prevention of Mother-to-Child Transmission of Hepatitis B at UNC Hospitals

Abstract

Background Hepatitis B virus (HBV) contributes to liver-related morbidity and mortality on a global scale. In mothers with active hepatitis B, up to 100% of mother-to-child-transmission (MTCT) is preventable. Guidelines from the American Association for the Study of Liver Diseases (AASLD) recommend that HBV vaccination and hepatitis B immunoglobulin (HBIG) be given to HBV-exposed infants in a timely manner to prevent up to 90% of MTCT. Additionally, AASLD guidelines recommend that women with high-risk HBV (those with viral load >200,000 IU/mL and/or HBV e antigen [HBeAg] positivity) receive tenofovir prophylaxis to further prevent MTCT. In this chart review, we compared UNC Hospital’s prevention of MTCT measures to standing AASLD guidelines. Methods This retrospective chart review included data from all HBV-positive mothers giving birth at UNC Hospitals from April 1, 2014 through December 31, 2019. We investigated the HBV status of mothers, time to neonatal HBV vaccination, time to HBIG administration, maternal HBV viral load, maternal HBeAg status, and whether tenofovir was provided for high-risk mothers. Data was then compared to AASLD guidelines distributed in January 2017. Results We identified 99 HBV-positive pregnant women over a five-year period. The rate of timely administration of HBIG was 99%. The rate of timely hepatitis B vaccination was 97%. The single neonate who did not receive the HBV vaccination within 12 hours was born to a mother whose HBV testing was initially positive but confirmatory testing was negative. Most (65%) women had documented HBV viral load and 75% of women had HBeAg studies. Nine women were identified as high-risk, with only one not receiving tenofovir. Conclusion UNC Hospitals were compliant with AASLD guidelines regarding timely neonatal vaccination, providing nearly 99% of neonates with timely HBIG and all but three neonates with timely HBV vaccine. The majority of high-risk women identified received tenofovir prophylaxis. However, there is room for improvement in laboratory evaluation to identify other high-risk women. While initial data is reassuring, quality improvement measures include improving testing rate to determine risk status for HBV-positive mothers and further investigation of appropriate follow-up testing for both mothers and children. Disclosures All Authors: No reported disclosures